>> we also need to expand the access to health savings accounts. i believe the president doesn't like health care savings accounts but he doesn't people to be in charge. that's what we're seeing reduction in premium, and particularly for younger people. i think we need to deregulate the state-based exchanges. a number of states have returned

the money. a number have got waivers. california was the first day to take the money because everything liberal happens in california. but we need to as i say support hsa's. we don't need government controlled state-based exchanges telling insurers what is going to be an essential benefit plan. we need to do medicare reform. we cannot continue with these entitlement programs, medicare, medicaid and social security as they have been going on. medicare will be bankrupt by 2024 if we don't make changes. when it was set up in 1965 the average person lived to age 65. today they live until age 80. we need to raise the eligibility age. we need to main step. why should a person like warren buffett of course pays less tax than his secretary, why should someone like warren buffett be on a government run program? medicare should be therefore the

people, the seniors that really needed. raise the eligibility age. then we can control costs. nancy pelosi said over and over again if we do premium support and these things, all of our seniors will be dying in the street. seniors will be dying in the streets and leslie make changes to these entitlement programs. then medicaid, we need to do change to medicaid. we need to do block grants to the state. this is an important part of the supreme court case on the power of the federal government to force states to expand their medicaid programs. the question i ask him who do you want to be in charge of your health care, a bureaucrat, a government bureaucrat or you yourself? as danny williams, the premier of newfoundland in canada, said i went to the states to have my heart surgery done because i couldn't get it in newfoundland and that's going to be on a long

wait in ontario. he went to mount sinai, paid out of pocket and had his surgery done. so when he came back, the canadian media was furious because this is their signature issuer, single player health care. he said i had done their because it's my health, it's my heart, and it's my choice. universal choice is the key to universal coverage. we are on the "road to serfdom" unless this legislation is repealed and replaced. the only solution. as or different p.j. o'rourke said if you think health care is expensive now, just wait until it is free. thank you. [applause] >> thank you all very much for coming out. and thank you to the heritage foundation for having me here. for those you're stuck inside

the beltway, first of all, i'm sorry, but second, you'll know that the heritage foundation, the cato institute don't always see eye to eye when it comes to health care. in fact, grace-marie often has to lock us in a room together until we can come to some sort of terms your but one thing we absolutely agree on, and that is the patient protection act is an absolute disaster, and needs to be repealed in its entirety. i'm going to focus my remarks today, just one aspect of it. and that is the cost. because even though the president only devoted 189 words of the state of being addressed to the question of deficit and debt, i believe that that is true the overriding issue of our time. after all, we're still borrowing 34 cents out of every dollar that this country spends. we have a $15 trillion on the book that at this point, and if

you include the unfunded liabilities of social security and medicare, our total indebtedness exceeds $120 trillion. in that context, the cost of obamacare becomes crucial. and if you all remember, of course there was that great moment just before obamacare past in which harry reid and nancy pelosi and the rest of the democratic leadership came out on the steps of the capital and there were nearly dislocated shoulders because they're patting themselves on the back so hard because they said that gotten the cost of the patient protection act down to just $940 billion. shows how long i've been stuck around washington because our member when 940 billion was a lot of money. now i realize it's a rounding error in the latest bailout, but it really is a substantial amount of money. the problem is that the ink wasn't even dry on the bill before that 940 billion number

began to unravel. it seems, for example, that the myth left out a few things. for example, there's the actual cost of implementing the bill. with congressional budget office estimate to be about $115 billion. that's the cost of everything from hiring all those new irs agents are going to have to enforce the individual mandate to hiring people to oversee the exchanges to the new insurance regulators, all of this is going to have a cost. but this isn't passionate authorized but not appropriate funds and, therefore, doesn't have to be counted as a cost of the bill because it is not being spent yet. will be in the future but they don't count it just yet. and then, of course, there was a little sleight of hand whereby they assumed that medicare would be cut by 23% in order to help

fund this. this was minotaurs doc fix idea. now, in fairness i have to say the 23% cut was in current law, had been since 2001, and every year congress has looked at this and not being particularly suicidal they postponed that cut. but in order to get the cost down to 940 billion it was assumed that in 2010 with a very first time, that cut would actually take place. and not to assume that anyone in washington is actually cynical, but at the very same time they were assuming that 26% cut would take place there introducing a separate bill to repeal that cut. when asked about that, they said oh, no, that's a whole separate bill. okay, it will cost $350 billion but that's over here, that's not part of our bill, can't count that as part of our cost. just think how much better your household budget would look if

you could see her mortgage was a whole different cost and you didn't have to county. that's essentially what they were doing. and so we didn't get the whole repealed of the 23% cut. we got the usual postponement of it. it's been postponed twice. if you have been watching the dustup over the bill to cut the payroll tax, you know, that part of that is actually another your postponement of the 23% cut. so we can so scratch that $350 billion savings as well. in addition to that there was some double counting that went on, famous washington bookkeeping will ways. the built decreases going for, and this was in addition to the 20% cut, an additional 500 they think they will say by introducing a whole bunch of efficiency by why the of the medicare advantage program and by doing something so that nature. they expect to save 500 billion. they use that 500 billion to quote extend the life of the medicare trust fund.

and simultaneously that same 500 billion times the cost of subsidies under obamacare. now, even in washington, spend the same dollar twice has a problem. so maybe you can't double count that but they also double count the social security taxes which go to pay social security benefits and to fund obamacare. there's a number of these gimmicks that are built-in. if you take all of these out, you at all because in together, you find at the real cost of this bill is upwards 2.5, $2.7 trillion annual at $800 billion to the federal deficit over the first 10 years of operation. that probably understate the problem because since then we've learned a couple other things. for example, they included $50 billion of revenue that came through the class act which is this giant ponzi scheme that took $50 billion in now and take it out beyond the ten-year budget window so they could count the revenue but they didn't have to count the payout.

since it turns out that the class act is not going to take place, it's not going to implement, so you have that $50 billion in cost. then finally there's a cost of subsidies under the exchanges. when the bill was passed they estimated about 9 million americans would be put into these health care exchanges in the states. the estimates now are in excess of 20 million americans will go in, and even that probably underestimates because there will be an incentive on behalf of business to dump their employees into the exchanges where it's cheaper because if you didn't have to pay the penalty of two or $3000 penalty for not injuring someone, versus $7000 for actually paying for the interest. if you can dump them in exchange the federal government will subsidize it and you don't have to pay for it as a business, you're much better off simply paying the penalty and getting your workers out of there and then you don't have all the

hassle of thing people come in and deal with your h.r. department because they're unhappy with your interest plan and all that, plus you save money. the more people that get dumped, the more subsidies the federal government will have to shell out. even if you just go from nine to 20 million americans into battle at about $500 billion to the cost of this bill over and above the 3 trillion or so that we are already talking about. so we just keep piling more and more costs into this bill. we are paying for it. we have about 600, 800 billion in taxes, about $3 trillion in costs plus if you notice, there's a shortfall. that's the problem we've been dealing with on behalf of the whole federal government. frankly you could have stumped up the entire state of the union address in two words, we are broke. we don't have a couple trillion dollars laying around to continue to pay for this very costly and wasteful and dangerous program.

so i think if you leave aside all the bad effect on health care that will hear about the increased waiting times, all the other bad things it's going to do, we need to repeal the send as a matter of fiscal sanity. thank you all very much. glaa[applause] >> good afternoon, everyone. thank you, for hosting us today. and thank you particularly heritage for hosting this. thank you all for coming. 2012 is the year that counts. this is the year that's really going to determine not only the future of health care in america but i really believe the future of our freedom. because if the law stands, what on earth can congress not commandeer us and the states to do in violation of constitutional principles. either we are going to turn our health sector in two centralized

system that controls via few delete policymakers, or we're going to get to work fixing the very real problems that do exist in our health sector. and putting in place policies that get the incentives right that the doctors and patients in charge of medical decisions, and that truly begin to reform medicare and medicaid. medicaid, which i truly believe is the worst health care program in america, and yet one that by the time this law is fully up and running, will have 87 million people in this program. that is not an acceptable outcome, and it still leaves 23 million people uninsured. we've got to fix this. when the court makes a decision, it could range from throwing out the whole law to letting the whole law stands, or some probably much more likely

complex range of decisions in between. i think the probably most optimistic and perhaps most realistic scenarios they declare the individual mandate unconstitutional and some narrow frame, that's what help i guess, wishful thinking, but the lead the rest of the long-standing which is really going to be a big mess. because people, people are really beginning to think that the president with the occasional times he talks about this law, he just mentioned a few things. 26 euros on their parents policies, a few of insurance reforms, free for free preventive care. they don't understand the massive complexity of this law. he never, for example, holds up this chart. that the joint economic committee did last year trying to depict one-third of this health law.

159 at least. so the american people, this is fairly confused about this law. the president, when he and his secretary sebelius talk about this, they just talk about these small provisions, not about the whole law and what it's a sweeping impact is going to be honor health sector. and the president really, i me, we heard in his speech last night, only 44 words devoted to health care. the administration is adopting a strategy of silence, after spending two years, almost come here and have, getting this health law passed. they stopped talking about it. not surprising because the law is usually unpopular. the latest tracking poll from the kaiser family foundation says the law remains as unpopular as ever. the majority of americans continue to oppose the law, an

overwhelming majority of check to the individual mandate. most because they believe it's an overreach of government power. but also because they think mandated insurance, insurance is expensive already and they know to going to get more expensive, and they're right when government is mandating what has to be and that policy. the individual mandate is center stage of course because of the upcoming supreme court argument. but another finding from the kaiser poll i thought was interesting. a majority, 55%, belief parts of the health law still would be implemented even if the court strikes down the individual mandate, and three in 10 think the road against the mandate effectively will mean the end of the entire law. so that really sort of feeds into the president trying to confuse things, to try to get people to thank.

it's just the small 20 six-year-old on their parents policies, the preexisting condition pool, the free preventive care, eventually filling the doughnut hole of the medical prescription drug benefit. after the 2010 election which i think really were a referendum on obamacare, the president was pretty belligerent in saying no, no, no. people really -- it wasn't about obamacare. i just didn't explain it well enough. and insisted that the law only needed a bit of quote tweeting, unquote. but i think his democratic legal advisers eventually got to him, and they and his white house advisers eventually reach a really inescapable conclusion. and i thought it was best put by democratic pollster pat caddell who said just after the election, the economy, as important as it was, was not the

decisive factor in this election. it was health care. it's health care that killed them, talking about the 63 democratic house members who lost their election. the american people found this to be a crime against democracy. they want it repealed and the issue is going to go on and on. what the american people wanted most from health reform was to get their costs down. so could there possibly be a more this name law than the affordable care act? i think not. mr. obama repeatedly has said during his campaign that health costs for the average family would go down by $2500 a year by the end of this first term. but costs are rising faster than they have in a number of years. another kaiser family foundation survey found that premiums for

the average family policy increase by $1300 last year alone. three times faster than the year before. and as many more mandates, from washington, those costs will continue to go higher and higher and consumed a bigger share of both family budgets as well as employer budgets. the $500 billion in new taxes, only some of which are in effect, will certainly increase that cost of health insurance for the. there's nobody else to pay for these bills but us, so one way or another, whichever pocket the taking out of, we are going to pay the bill. a number of factors of course contribute to rising health care costs, but the mandates and the taxes and regulations in this new health law are going to send costs soaring. the congressional budget office assumes that the average family

policy will cost $20,000 a year by the time the law is fully up and running in 2016. and remember, that policy is no longer going to be optional. it's mandatory if the supreme court upholds the provision of the law. so $20,000 a year to purchase a health insurance policy at the government tells you, you have to have. mckinsey and company assumes that tens of millions of people are likely to just say, i'm not buying this policy. the government has to sell me a policy anyway if he government is requiring insurance companies to sell me a policy anyway, so why should i buy a policy if i can buy it at the time i need for the price, the same premium i would've been paying from buying all along. and already we're seeing that happening in massachusetts with this individual mandate. so we may actually wind up with a worse problem of uninsured, as

americans follow the incentives. should i spend $695, or to put 5% of my income, or by a $20,000 health insurance policy, the same thing will be true with employers. as they begin to figure out that they can send their employees to the exchange and eliminate this cost and pay the fine. former congressional budget office director douglas holtz akin assumes as many as 35 million additional people will wind up in the taxpayers subsidize exchanges, as a result of the incentives for them to be dumped from the employer plan into exchanges, and we can have a whole other conversation about exchanges, but do we really very like a windup in coverage that is not going to look a lot different than medicaid does today. and medicaid does today, and what we know is that medicaid pays doctors and hospitals so

little and especially private physician, but they just can't afford to see physicians. four in new york, some visit is $7 for an offices. they can't possibly pay their nurses or pay the overhead for that. and yet that's the program that we are expecting people to go into. so the president wants us to think that it's just the small stuff, 26 year old, free preventive care, and this whole tsunami is coming at us that is, that the president is reelected, if this law stays in place, even if the individual mandate is a drop down, there are huge, huge problems with this for our economy. i believe job creation will continue to drop off. we already see, new cd is in a band where i live, and they put in automatic checkout faciliti

facilities. lower wage jobs are going to vanish because employers simply can't afford to pay the huge health insurance costs, or even the fine for lower wage workers, and they were replacing them with technology, the very jobs people need to get their foot on the latter, to get into the workforce, are the ones that are going to be killed first by obamacare. imagine also when you have employers and maybe tens of millions of americans deciding to violate federal law as a matter of the family budget decisions. what does that say about our civil side in america? what is that going to mean for our country when considering the people and hundreds of thousands, maybe of millions of businesses decide to violate federal law? i think that's really going to

have a corrosive effect for our economy and for our ability to function as a civil society in this country. and one final thought. i was talking with a very wise staff member on the senate side, e-mailing back and forth over the weekend, about this latest directive from health and human services that catholic hospitals and catholic churches, meaning catholic employers, must provide preventive care that includes contraception, including drugs that produce abortion and sterilization as part of their health plan. where they would be fined. and the president apparently called the president of the u.s. council of catholic bishops, timothy dolan, before the announcement was made single worry about it, we are giving you a year to comply.

and timothy dolan rightly said after that, they're giving us a year to figure out how to violate our most fundamental conscience and principles? it's not going to work. so they put them in a very, very difficult position of saying we're either going going to violate federal law, a defined or violate our conscience. none of those are optional solutions. and so that's an example, i think, of why it's not just individual mandate that is in question before the supreme court. the very dna of this law is unconstitutional. it's commandeering of the states, violating the 10th amendment, violating the first amendment as we said with a violation of religious freedom. first amendment guarantee of religious freedom and individual mandate, whether or not that is upheld is part of the clause.

if it is, then what does our constitution say about the ability of free citizens to govern ourselves, make our own decisions? or whether or not the federal government is going to come in and order our lives and confiscate our own personal property and tell us, you have to spend $20,000 a year of your family budget, even if that's more than you're paying for your mortgage or your rent. in order to comply with federal law. that's why this law must not stand. if the court upholds it then will be back at the ballot box in 2012 and the american people are going to have the final say on this law. thank you all very much. [applause] >> wonderful. i think all three of you for actual remarks money us again, almost two years later, the problems that we have with this health care law.

i just want to underscore another trend that we see which is this is just what we know today. there is still mounds and mounds of regulation and information that we will still have to wait to see. so i think that really underscored the danger of moving forward with this health care law, because we even today are not clear as to what the final package will look like. we have time for questions, so please if you have a question for our panelists, please raise your hand and we'll bring you a microphone. start one down there on one in the back. >> how is it politically possible to repeal this thing if you need 60 senators to do what? and the most optimistic scenario you will not have 60 senators? [inaudible] he has written a detailed post on this. is now with the hoover institution i believe, stanford,

and he said because much of the law involved spending, that you really only will need 51 votes in the senate in order to repeal. most of the provisions, michael particularly talked about, you can't spend any money, and the rest of the law really is not going to have, is going -- the majority in the house, and remember, that it has a big piece of this through reconciliation in 2010 in order to get it through after scott brown was elected in massachusetts. they only had 59 votes and is it. so a lot of it could be undone through reconciliation, and you might google keith hennessey to look at his description. been a good question. any of the comments? [inaudible]

>> in your study, trento, you mentioned insurance companies would be able to -- [inaudible] >> the problems with evading the provision is it would be even worse than the current situation. the fact is, insurance, it's expensive to insure people who are sick. this sort of precondition situation is like being able to drive your car into a tree and then pick up the phone and say geico, that's a good time for me to have that auto insurance. you're waiting until you're already sick and then you're becoming insured. that's a great actress for insurers. you can pass a law saying in insurance can't deliberately discriminate against you, okay, injures will comply with the law, but what will they do? you have a lot of insurance offices there on the sixth floor of a walk up so that is much harder for sick people to get up

there to come in and sign the paperwork, which they will do. or the easiest thing is you just don't have come if you don't want a lot of cancer patients, for example, in your insurance plan, you don't sign of any oncologist in a network of doctors. so that basically if you have cancer you are looking around for which insurance policy to join, i'm not going to sign up for this one because i won't have to get treated so i'll have to go here to this other one. so what you will start seeing is a rush from quality among insurers as they basically cut have a lot of health, very few procedures to pay for people who are actually sick so they will have heart surgeon, what have oncologists. you would change the nature of interest to one that increasing retreats healthy people and stop treating sick people. what you want to do is lower the cost of insurance for people young and healthy by removing a lot of the regulations and mandates making it much cheaper for people to sign up when they're young and healthy and

allow them to stay in the plan throughout their lifetime as they get sicker, the insurance companies build the cost in and that makes much more sensible market. [inaudible] >> you constantly chase the wheel, so to speak. you can constantly try to come up with new regulation but people are always smarter, they'll always find a way around it and it will end up costing a lot more, producing a lot less care. >> i wish is going to add that under the affordable care act they put $5 billion in to help those people who have preexisting conditions if they've been out of work for six months a more. richard foster said it will be gone by 2012. this is between 2011 and 2014. they said the administration

said about 400,000 people would be moving into, to get the insurance in high-risk pool. only 41,000 people have actually signed up for the insurance in the states hybrid pool which makes one wonder how may people there really are with preexisting conditions. but even though so few have signed up, about five states have come back saying there's not enough money here for us to make the high-risk pool work. so they're asking for more money from the fed. switches shows the example, this is going to cost us so much more than the administration and the cbo have ever said. >> also, one of the reasons the state has been more is because when the premiums were set at the legal level, according to how the law was written, few people were buying interest because it was so expensive. so they sent out a new directive say no, we're going to cut the cost of the insurance so the insurance is less expensive and, therefore, they're running out of money even faster.

the government just doesn't understand how to make a market work. on the markets know how to make a market were. washing does things for directives, and it's just not going to work. >> we have a question back there. >> isn't the insurance for the 26 year olds at least $3000, and as far as universal access -- [inaudible] >> finally, romney saying -- is totally incorrect.

[inaudible] [inaudible] >> just real quick on the whole idea of universal coverage. i think it's a mistake to focus on the number of people with insurance as opposed to a healthier population. we tend to conflate the idea of health with health care, with health insurance.

and the three things are entirely given. with a goal at the end of the is a healthier population. one way to do that is to health care singh doctors and hospitals and so on but it's not the only way. one way to pay for some doctors and hospitals and so one is to health insurance but it's not the only way. and in terms of your bang for your block, the studies repeatedly show that buying insurance from someone is not give you the biggest bang for your buck in terms of health on the down. you might be much better off using that staying active in other ways, or you might be better off putting that money on something that has nothing to do with being seeing a doctor but has more to do with health, promoting healthy lifestyles, getting people to eat better or to work out more, things like that that have much their impact on health benefits at the bottom and. so we shouldn't necessarily judge the success of a health care plan by whether or not it gives a whole bunch of people coverage.

having a piece of paper in hand us as this is health insurance isn't a guarantee that you can see a doctor. everyone has universal health coverage but you wages your doctor. simply seeing a doctor isn't going to make you healthier, if you go out, stop exercising, eating much and don't follow the the the doctor's advice, it's not going to do you any good. so the three should not be conflated. >> the administration is saying now to put 5 million kids are on their parents health care plan until the age of 26 of this is a huge success. but as grace-marie said the kaiser family foundation showed that average family premium last year was $15,000, up 9%. the previous year was only up 3%. i wonder of those to put 5 million children of to the age of 26 how many of them had individual plans before and he said it was cheaper to leave and go off and join their parents plan. that is something i really want to look into because there could be a lot of shift just one type

of insurance to another. >> i think we're fortunate enough here to have former congressman john shed, even though he is behind the pole there, so i can't see. i hope that is you. >> the extraordinary cost of this legislation -- in addition over the last year, outrageous theories including out of work. [inaudible]

>> congressman, what we most need is your continued leadership. i wish are still in congress and you believe the charge of how we make sure obamacare stays a key issue in 2012. fortunately the house is going to be taking up the repeal of the class act, the long-term care provision that democratic members have called a ponzi scheme of the first order. they will be taking that up next week. i believe they have the independent payment advisory board, the rationing board and medicare up for debate. there's certainly going to be attention to the employer mandate in its focus on killing jobs. so i think that's right. i think they need to continue to keep the focus on this law and shine a light on it. one issue after another so that the american people do

understand that it is so much more than the six, half a dozen things the president will talk about. and it really is this monstrously complex law. your leadership in getting us to understanding to how we can reform health care reform, and the right way, has been crucial important and i'm glad you're continuing to be affiliate with the heritage foundation to keep your voice in the public domain. we need your wisdom. >> i would say part of the problem is, let's say that congress has the attention span of a gnat -- [laughter] and they figured they promise the first vote they would take on appeal. it died innocent like everything does, and they said well, we did what we said, let's move onto debating some of the crucial issue. naming post offices or whatever. and it did come out today, it was announced today they will

finally have, they jarecki to come up with a replacement plan. it was announced today they will find have a replacement plan that they will announce sometime after the supreme court rules on the legislation of the whole. they don't seem to be in any rush to get out and do this. and i think it's partly because the pressure has been off. people have gotten cynical. we all want to repeal it. if you've seen the numbers, 53% in the latest poll still want to repeal it. it's about 15-20-point margin of all the polls say that they want to repeal it. the bill has not gotten more popular, no matter how may times it's been explained to people. but there's only other things on our mind, and people are not calling the congressman. they are not running, not asking for to be repealed in the. frankly, they move on. >> i think that it's so very

important that we keep the drumbeat up. op-ed's, radio shows, we've got to get the american people reengage. they were engaged in the election of november 10 and with got to get this back up. norman coleman, the former republican senator from minnesota, just yesterday who was an adviser to met romney said the gop as not going to repeal the. i thought where is this coming from? it's not going to help mr. romney's campaign. we've got to keep up the pressure for why it is so important. because if mr. obama is reelected in 2012, he will continue to veto repeal bill. with the senate on january of last year, and it's just so very important that the drumbeat, because in canada, you know, since 1974 we still have the single-payer system. there are some private clinics illegally that are working but by 2014 it will be impossible to get rid of this government program. you can never get rid of government programs when they're in place so we've got to do in

a. >> i just want to underscore that's why it's so important as this court case becomes the topic of the news of the day as the case gets closer, that we also don't forget to put, that putting all our eggs in that basket is going to solve this problem. we must be vigilant we can't just depend on the courts to grant to depend on congress to do their job and to do the job completely and fully and continuing the road to full repeal. >> next question. >> my name is doctor unger, one of the doctors. i'd like to take my scalpel to this whole problem on that, if i could just cut it. let me ask you first economy for everybody. the system could perspective we could come into existence, the impact on that as it intertwines with the declining reimbursement of electronic medical records could have another colossal leak

damaging effect on the system, mostly what we are talking about shortages of just about everything. most of you know that there's now a very alarming shortage of oncologic drugs. and we see shortages of immunization. we see shortages of nursing care. and we see this every day. but i have a question, if there's a lawyer in the room, what would happen if the following took place, and insurance company moves into the area of pennsylvania and sells insurance without any mandates at all? pennsylvania has 53 mandates. these are those other mandates that don't get talked about. what happens then? they sell very low cost insurance that has very high quality and very high coverage, and it actually pays people and in incredibly way. what happens after? >> it would be illegal under pennsylvania law. they would not receive a license

in the state and, therefore, their entire business activity would be illegal. >> if the law in pennsylvania were worded loosely enough -- [inaudible] >> no. [inaudible] >> this has been litigated. it's a essentially, the insurance commission has the power to license who sells insurance industry. if you don't the license in the state you're not allowed allowed to sell insurance. >> and it wouldn't fulfill the individual mandate either. >> if i may take the liberty of asking question, that follows with that, which is if they helped a lot does go into effect will be in your opinion have yet another two-tiered health care system for the haves and the have-nots? >> a lot of people say i'm going to be all right, i can afford to pay whatever i need for health care and i will make sure i had a catastrophic policy. i think that is just, the health and system is just a network, it's a web, it's a vital integrated system in which

hospitals provide better surgery because medical device companies are able to come up with new and better surgical techniques and diagnostic techniques, and machinery. drug companies are able to produce new and better medicines that doctors can prescribe, key -- keep people out of hospital. the incentives are wrong. so the pharmaceutical companies have to go through so many hoops to get their drugs approved. at some point they either have fewer drugs or they just can't do that anymore. health insurance companies, we see them, i have a paper on our website called radical restructuring of health care that talks about health insurance companies simply leaving states because they can no longer figure out how they can comply with all the rules and regulations, and make a market in health insurance. and doctors, 40% of doctors thinking of leaving practice

when this law is fully in effect in 2014. the infrastructure of the health system declines, and yet some people will be up divide that we have. we may have offshore hospital settings being created. but the quality of health care in america will decline for everyone, and people will not be able, if the drug is not created, there's no way you can get that drug. ..

>> they're going to have brand name drugs covered under the doughnut hole where they were going to generics and stuff, so they came out ahead. big insurance, you know, they dropped the public option, and they got a mandate that people have to buy their product. it's a $7 o billion a year for the insurance industry. now, the small and medium insurance companies, they can't comply, thai -- they're going to go out of business, but that's great for the big insurance companies. the ama lobbied this bill because they think it's going to mean their doctors are going to get special treatment under this, they're going to get the doc fix put in and thing like that. so i think this is a great bill for big business. i think it's just the little guys that are going to get stepped on in terms of all of this. >> and, of course, it's amazing that the american medical association only represents about 17% of doctors, yet the man on the street thinks the ama represents every single doctor.

my worry as i said in my little talk is that, you know, private insurers will be crowded out a lot of docs say, well, we're just going to do our private concierge practice, and we'll be fine, but when the provinces in the federal government of canada took over the system, the canada health act outlawed any private medicine or payments, so i think we have to be very aware this could be an ultimate, um, consequence of the affordable care act if it's not repealed and replaced. private medicine could be outlawed, and we'll all be in the medicare for all system. >> better get our frequent flier miles ready then. question up here. >> if this bill is as unpopular as i believe it is too, why is it our three top presidential contenders are all each in their own way for some form of obamacare, and apart from the question more practically, what do we do as voters come november in the presidential election?

>> yeah. you know, last night newt said he wanted to make the moon the 51st state. [laughter] so i'm thinking of moving there. [laughter] you know, it really boggles my mind. the fact is, and we talk about why are we not doing more to repeal it, the fact is the two leading presidential candidates on the republican side right now supported an individual mandate. mitt -- newt at the federal level, mitt at the state level,? they support exchanges. they both support a lot of the insurance regulation that's going on, the community rating and guaranteed issue provisions. i mean, for all that they are busy firing barbs at each other, there's not much of a dime's worth of difference between them on health care. they both supported the $17 billion medicare part d, both of them were in favor of it. so it really is hard to draw a

contrast, and i think it's going to be much more important at the congressional level who the congressional and senate candidates are and where they stand on this because, you know, they're all giving lip service to, oh, they'll repeal it. i don't see either of them leading the fight. you know, they'll sign it if it comes out of congress. so, you know, that's where the fight's going to have to be. >> i think that's right. i think congress is going to really have to lead on this and the bill shows up on the president's desk to repeal as much of it as they can, reconciliation's necessary this the fed, then all you need is a president who'll sign that because i think that it's -- romney says he'll repeal, you know, repeal is the first thing he wants to do, but then he says, he says, well, and we have to repeal it or replace, and i'm glad i've shown what i would replace it with. [laughter] that's not cutting it. >> and it's interesting, i mean, i keep -- well, all three of us have been critics of romneycare, so probably mr. romney's not

going to ask any of us to be secretary of hhs. [laughter] but i just can't understand why mr. romney will not say i thought it was a good idea for massachusetts, we have the evidence, and it's not good, so i made a mistake and, therefore, but he won't do that. but that's what makes it very frightening. so i'm going to buy an old ship, not the one that crashed off the italian coast. i'm going to set up my liberty ship, and we can all get our health care on my liberty ship. [laughter] >> i would also like to underscore what mr. shad dig said, this is why it is so critical that congress gets it right this summer. it will set an important tone on where the future of the health care system should go if health care law can get repealed. and i will say, also, that it should be a cohesive plan and not just a kind of alphabet soup of everyone's idea that makes no sense. i think we need to be able to explain to the american people, as has been done in this book and heritage's plan on saving

the american dream and everyone else has their own ideas of what to do, but they all fit together in an important way, and i think that's another important feature moving ahead as this debate continues. do we have anymore questions? we're bumping up on our time, but -- >> to the congressman's point who i have a great respect for on the house's side with repealing the entire law, i know that there's a messaging battle, there's more conservative members in the republican caucus that are for outright repeal and only outright repeal. so how do we move to or move away from if we repeal portions of the law, class act, device tax, everything else, like, the horrible portions of it, how to we move to where we're not making a bad law better? >> there's a huge amount of discussion on, in the congress on exactly that point. if you repeal it, will you

improve it? i think that's such a misunderstanding of how truly monstrous this law is. i mean, you could take, they could pass a law, pass a bill every week between now and november whatever election day is, 6th, and they would only on the margins be able to make this law better, and it would still not pass the senate. so the house has to continue to keep up the trum beat as -- drum beat as a way of educating the american people about what really is in this law. they had a huge part of this law they just put in there in order to be able to pretend that it was a deficit reduction law. and it's just outrageous. and you shine a light on that. and then you talk about the independent payment advisory board. then you talk about the employer mandate and be its job killing. they just need to keep up the drum beat, and there are some members, i think that they have sort of begun to realize you need to have handles to explain to people what's in the law or

they're just going to believe that the president's right when he says, oh, don't worry about this, it was just a bunch of the small stuff. all we were doing was putting 26-year-olds on their parents' policy. the only way they're going to understand what's in the law is if congress continues to say here's what's in this law. $575 billion in new taxes, half a trillion in cuts to medicare, the unbelievable expansion of medicaid that's going to bankrupt the states, mandates on businesses, the mandates on individuals, all of those part of the law that should not stand. >> okay. well, we'll try to take one more question if we have it. going once? okay. one more in the back. wait for the microphone, thanks. >> um, with the medical loss ratio, there's been talk about the impact it will have on health savings accounts.

it doesn't appear that they're canceling these plans right now from what identify seen, but you can't talk about what kind of time frame we're looking at and perhaps address that. >> well, yeah. we don't know for certain yet what the impact will be on health savings accounts because the rules haven't been written yet about what's going to count in terms of the medical loss ratio. a lot of it depends on how, which side hhs comes down on, how are employee contributions treated, how are the individual payments out of the account treated, what way do all these things count against the minimum payout requirement that's in this. so we know that some that are set up now probably will fail under any structure, some may qualify, a lot remains to be seen how the rules go into effect. i believe we're talking not until 2014 until, until everything goes into place, so that's when the real impact will be.

i suspect before the election there'll be a lot of talk about how lenient these rules will be because you don't want to frighten anybody, and then after the elections the rules will appear to be very tight because we know the president actually has said he does not support health savings accounts. he has talked about that. he thinks they're based on a myth that people overconsume health care, so he thinks that, he thinks that this is a wrong approach, and i think he's not going to be very sympathetic to them. >> the real concern with these medical loss ratios where the federal government is telling health insurance what percentage of the premium it has to spend for, um, actual medical care versus administrative costs. the problem with health savings accounts is that the insurance itself doesn't trigger in until people reach their deductible which is higher, which is why the insurance is cheaper. but yet the insurance company has to keep track of the, has to know that you've reached that

deductible so, therefore, they have to do all the administrative cost of making sure of really figuring out you used that $50 on this doctor's visit, $900 on your meds over here, so they know how to get to that point. so even though they're spending less on medical care, they still have to do the administrative costs to figure out if someone's reached that deductible. and that's what i -- they're killing them. if they want to put in this law we're going to get rid of health savings accounts, i think you would have had a hard time passing it because a lot of conservative democrats see they're valuable. they're killing them, strangling them through regulation by saying here is this really narrow, prescriptive rule, and health savings accounts just aren't going to be able to comply with it and, there there, they would not be legal policies. there are other examples, but that's a specific one to show why i think they really are on

the chopping block. but it's way out in the back 40. >> and i was going to say about 12 million americans have hsas, and they are very popular. particularly among the younger population that want insurance to be there for insurance purposes, catastrophes. but as michael said, the president doesn't like them, and, you know, a few small companies that only offered hsas have already gone out of business. so that's a precursor. and then if you look at the flexible savings accounts that you were able to put off $5,000, this year it's $2500, so we're seeing the end of that. so i think the writing is on the wall for the fact that this is not something that's part of the agenda on the president or hhs' agenda, ie, the continuation of hsas. >> the way the rule, what comes off as a question as grace marie said is you've got this pilot paid first out of the hsa. well, if that doesn't count as a payout against the premium, then you get into the problem where

the insurance company's running up costs and not making a payout, and they're going to be in violation of the rule. now, so if that payout is counted as being paid out against the premium, it might qualify. but then you have the other problem, what about the contribution that the employer makes to the health savings account? is that counted as a poem premium cost in which case you just made the premium more expensive, and the payout may not qualify as meeting the minimum loss ratio or not. that's why these rules are going to be very important for how they play out. >> they basically say that the if a person pays for medical care out of their health savings account, that doesn't count. >> right. >> it only counts if insurance company pays for it. >> but they're not designed that way. >> but they have to calculate how much that individual has paid this medical expenses and part of the administrative costs. so it's just, it's really, it's a very demonic way, i think, of killing health savings accounts indirectly rather than doing it

more explicitly. >> and they all, they've already said you cannot use, um, your hsa account for over-the-counter meds. so what does this mean? people go to the drugstore and get a med, now if they want that medicine, their going to have to go to the doctor, get a prescription, and this adds to the cost of health care. >> another gift of big pharma. you don't use it for the generic drugs or the stuff you get over the counter. instead, you get a prescription for a brand name drug, you can buy that with our hsa. >> i would just like the end it by saying i guess like we say at the heritage foundation, details matter. and the more the american people know the details, i think the less they will like it. so thank everyone on the panel. we do have books available when you came out, so please feel free to pick one up. but let's thank the panel one more time. [applause] >> we'd like to hear from you. tweet us your feedback, twitter.com/booktv.